We are at a critical juncture in healthcare. The convergence of a focus on efficiency, adoption of technology, population health, changing reimbursement, consolidation and the patient experience are almost more than the workforce can bear. These things are all important but we must simplify and streamline how we address this work. Edward Deming, the father of systems quality, stated that 94% of problems are systems driven, and only 6% are people driven. The creation of a highly reliable organization should be our focus. One that consistently and seamlessly delivers competent and compassionate care to the patients we serve. However, we cannot do that unless we address the emotional exhaustion and burn out of our workforce. Susan Ehrlich, M.D., of San Mateo Medical Center put it well when she said, “The word ‘Lean’ sounds terrible in a healthcare environment.” Instead, San Mateo took the Lean concepts and made them their own through a process called LEAP – Learn, Engage, Aspire, Perfect. That kind of change helps healthcare professionals align to purpose instead of just stripping out waste.
The words we use matter. As a result of focusing solely on efficiency, doctors, nurses, and other frontline leaders and staff are getting burned out and fatigued. They are losing their passion for medicine and leaving the profession too early, which is contributing to a shortage of staff and a strain on innovation. Why must young health professionals join startups to do interesting, meaningful work?
And if you look at the things we’re focusing on as an industry – things like population health and evidence-based medicine – these aren’t the things that patients care about. In an opinion piece published in JAMA in 2011, Allan Detsky, M.D., PhD, asserts that consumers place a high priority on things like easing the burden of illness, the timeliness of care, kindness and compassion, hope and certainty, continuity and choice, and the trust they feel in their relationships with providers.[i] Their lowest priorities are on the efficiency of the health system, statistics (they are more swayed by anecdotes and stories), and equity (as long as they and their loved ones get good care, they’re less interested in broader care access). Somehow, as healthcare leaders, we must balance the needs and priorities of healthcare consumers with delivering care in an efficient and cost-effective manner – all while addressing the emotional and physical needs of physicians and staff.
Our recent research shows that we have a long way to go. Over the past two months, we surveyed more than 80 healthcare executives and conducted in-depth interviews with more than 30. What we learned was that while leaders are just as likely to cite experience as a key outcome along with quality, safety, and efficiency improvement efforts, on average, organizations dedicate 3x as many staff to quality and safety initiatives compared to personnel focused on experience improvement.[ii]
And even if health systems have the best intentions, they still often miss the mark because they don’t view patients and families as true partners and co-designers in their improvement processes. Only two leaders out of 83 said patients and families are always present during all stages of process improvement. Patients want to be part of defining and solving problems. During our recent webinar on patient engagement, Regina Holliday, patient activist and artist, lamented that she was once involved in a patient and family improvement council but that, “unfortunately, we got to design a lobby.” She went on to say, “Many hospitals don’t get what true patient advisory councils could be . . . we’re valuable in understanding how workflow can affect us.”
Some systems are getting it right. Shawn Evans, PhD, SVP of Performance Excellence at University of Colorado Health (UCH), shared with us that his system has a policy: “Any change that’s more than three people and three process steps, we must have patient perspective in the room.” That belief in the wisdom of patients has helped shape a culture of patient-centered innovation at UCH.
Even systems that put a lot of effort into improvement don’t always succeed. When we asked leaders to choose the top three reasons that improvement efforts stall or fail, the top reason was failure to hold people accountable, at 81%. But the number two reason was that frontline leaders and staff have too much on their plate, at 59%. We are sapping the energy and vitality out of frontline doctors, nurses, and other care team members. This has disastrous consequences for team members and for patients and families. The percentage of patients who would “definitely recommend a hospital to friends or family” decreases by 2% for every 10% of nurses at the hospital reporting dissatisfaction with their job.[i]
Unfortunately, our research shows that physician and staff well being are only a top priority in improvement efforts for 17% of the health leaders we surveyed. And while 76% of respondents measure baseline and follow up values for patient experience, only 15% and 11% do so for staff and physician burnout, fatigue, or exhaustion respectively. By ignoring physician and staff well being, organizations risk higher error rates, attrition, and other negative results.
As healthcare industry leaders, we have to aim higher and focus our efforts on what really matters and find the leverage points to drive change. Adopting best practices will just get us to the national average. Our patients deserve more.
Simplification of healthcare for everyone would ease the burden of suffering for all and improve outcomes. We must co-design with patients as partners to do this. If we drive innovation that simplifies healthcare, we must eliminate the bureaucratic practices we have in place. We have to look outside our industry for solutions that have simplified and eased the burden of antiquated processes. Take transportation. Uber is a ride sharing service that is quickly displacing traditional taxi businesses because of its comfort and ease of use. We can learn much from this innovation. Amazon prime has items delivered to your doorstep in hours and overnight and knows your preferences better than your spouse! Why can’t we track and understand our patients preferences like their hopes, fears and concerns and design the system to meet those needs.
Read Pierce, M.D., Associate Director, Institute for Healthcare Quality, Safety, and Efficiency at UCH summed up the opportunity nicely when he said, “We can liberate the system from wasteful or silo-based practices to simultaneously improve efficiency while restoring joy, meaning, and mindful focus.” Our goals for this group are to:
[i] McHugh M, et.al. Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care; Journal of Health Affairs, February 2011 vol. 30 no. 2 202-210.
[i] Detsky AS. What Patients Really Want From Health Care. JAMA. 2011;306(22):2500-2501. doi:10.1001/jama.2011.1819.
[ii] Source: Experience Innovation Network Research Study, Humanizing Efficiency in Healthcare, November 2015. http://solutions.vocera.com/HumanizingEfficiencySurvey.html